Journal of thoracic disease最新文献

{"title":"Novel cardiac computed tomography-based preoperative indicator associated with intraoperative graft flow in coronary artery bypass grafting.","authors":"Xiaohang Wang, Shen Lin, Wei Feng, Dong Zhao","doi":"10.21037/jtd-2026-1523","DOIUrl":"https://doi.org/10.21037/jtd-2026-1523","url":null,"abstract":"<p><strong>Background: </strong>Graft flow in coronary artery bypass grafting (CABG) is linked with blood distribution of the target vessel. In this study, we aimed to develop a novel quantitative measurement of target coronary artery quality using coronary computed tomography angiography (CCTA) and investigate its correlation with intraoperative transit time flow measurement (TTFM).</p><p><strong>Methods: </strong>We enrolled 68 patients with CABG who underwent preoperative CCTA. Target coronary artery volume index (TCAVI) was calculated from CCTA images and measurements in 65 arterial and 94 venous bypass grafts. CCTA-TCAVI, representing total volume (mm³) of arterial vasculature per individual target artery, was statistically analyzed for correlation with TTFM.</p><p><strong>Results: </strong>CCTA-TCAVI demonstrated a positive correlation with mean graft flow (MGF =0.222, P=0.005). TCAVI was linked with abnormal internal mammary artery (IMA) grafts [intraoperative MGF <20 mL/min and pulsatility index (PI) 5] and saphenous vein grafts (SVGs, <40 mL/min) and PI (5) odds ratio (OR =0.99, <1, P=0.004). Interquartile range (IQR) analysis revealed a significant correlation between abnormal SVG and TCAVI (P<0.001), but no correlation between abnormal IMA and TCAVI (P=0.91). Compared with previous predictive measurements, TCAVI correlated with graft flow(MGF =0.222, P=0.005). The cutoff value for CCTA-TCAVI was 200 mm³. Compared with coronary stenosis percentage, TCAVI prediction accuracy was 13% higher.</p><p><strong>Conclusions: </strong>TCAVI as a novel measurement may be useful to appropriately select the optimal target arteries at the time of CABG. It may have clinical potential to predict intraoperative abnormal venous grafts with high accuracy.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1031"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and treatment of GOLD stages I and II chronic obstructive pulmonary disease.","authors":"Wei-Jie Guan, James D Chalmers, Yong-Chang Sun, Alvar Agusti, Pi-Xin Ran, David Halpin, Shi-Yue Li, Gerard Criner, Yu-Min Zhou, Omar Usmani, Rong-Chang Chen, Antonio Anzueto, Fu-Qiang Wen, Claus Vogelmeire, Sundeep Salvi, Jin-Ping Zheng, Nan-Shan Zhong","doi":"10.21037/jtd-2026-2449","DOIUrl":"https://doi.org/10.21037/jtd-2026-2449","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1004"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical utility of CT-based deep learning for differentiating pulmonary aspergillosis from bacterial pneumonia: a multicenter retrospective study.","authors":"Tianyu Li, Ronger Zhang, Huanyao Zhang, Deyan Chen, Junnan Pan, Jiejia Chen, Wei Wang, Chengbao Peng, Fan Yang, Xia Zhang, Zhengtu Li, Jinping Zheng, Feng Ye, Yun Li","doi":"10.21037/jtd-2026-1253","DOIUrl":"https://doi.org/10.21037/jtd-2026-1253","url":null,"abstract":"<p><strong>Background: </strong>Early differentiation of pulmonary aspergillosis (PA) from bacterial pneumonia (BP) remains challenging in respiratory practice because of overlapping clinical and computed tomography (CT) features. Conventional microbiological and serological tests may be invasive, delayed, or insufficiently sensitive in selected patients. This study aimed to develop and externally validate CT-based deep learning (DL) models as adjunctive tools for differentiating PA from BP.</p><p><strong>Methods: </strong>This multicenter retrospective study included patients diagnosed with PA or BP at The First Affiliated Hospital of Guangzhou Medical University and The Second Affiliated Hospital of Guangzhou Medical University. CT images from The First Affiliated Hospital of Guangzhou Medical University were used for model development and internal validation, while data from The Second Affiliated Hospital of Guangzhou Medical University were used for external validation. Two CT-based DL models were developed: an unannotated supervised training (UST) model using CT images without manual lesion annotation and an annotated supervised training (AST) model incorporating physician-annotated lesions. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). A standardized image-only questionnaire was also used to explore clinician performance in differentiating PA from BP.</p><p><strong>Results: </strong>A total of 387 PA cases and 311 BP cases were included. In internal validation, the AST model achieved an AUC of 0.83 [95% confidence interval (CI): 0.76-0.90], with 81.7% sensitivity, 73.2% specificity, and 78.0% accuracy, whereas the UST model achieved an AUC of 0.78 (95% CI: 0.69-0.86). In external validation, the AST model achieved an AUC of 0.81 (95% CI: 0.71-0.92), compared with 0.56 (95% CI: 0.41-0.70) for the UST model. In the standardized image-only clinician assessment, 158 valid responses were analyzed, with an average diagnostic accuracy of 68.2%. Exploratory analysis suggested that model performance varied across disease stages, highlighting the potential influence of temporal radiological changes.</p><p><strong>Conclusions: </strong>The annotated CT-based DL model showed potential as an adjunctive imaging tool for differentiating PA from BP. However, the external sensitivity of 60.6% indicates that the model should not be used as a stand-alone diagnostic or rule-out tool. Prospective multicenter validation and integration of clinical and microbiological data are required before clinical implementation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1030"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preserving genome integrity to combat cardiac aging: beyond LINE-1 and cGAS-STING.","authors":"Ahmed Abdel-Latif, Nageswara R Madamanchi","doi":"10.21037/jtd-2026-2275","DOIUrl":"https://doi.org/10.21037/jtd-2026-2275","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1073"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seven years of PARTNER 3: the evolution of a lifetime valve strategy, reassurance and residual uncertainty.","authors":"Kelechi Weze, Faisal Rahman","doi":"10.21037/jtd-2026-2404","DOIUrl":"https://doi.org/10.21037/jtd-2026-2404","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1081"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of analgesic efficacy and safety between liposomal bupivacaine and ropivacaine for paravertebral block in patients undergoing thoracoscopic lung tumor surgery: a prospective double-blind randomized controlled trial.","authors":"Yi Zhang, Heli Gao, Xue Zhang, Huiling Li, Xiawei Hu, Honggang Zhang, Xiaoxia An","doi":"10.21037/jtd-2026-2185","DOIUrl":"10.21037/jtd-2026-2185","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Thoracoscopic lung tumor surgery is associated with significant postoperative pain. While liposomal bupivacaine (LB) provides prolonged analgesia, its higher cost and extended duration profile have not been directly compared with ropivacaine, a commonly used long‑acting local anesthetic in paravertebral blockade. Whether these differences translate into meaningful clinical benefits remains uncertain. This study assessed the utility of LB as an alternative method for pain control through a comparison with ropivacaine.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this prospective, double-blind, randomized controlled trial, 200 patients scheduled for elective thoracoscopic lung tumor surgery were randomly assigned to control [paravertebral block (PVB) with 10 mL of 0.75% ropivacaine; n=100] or experimental (PVB with 10 mL of 1.3% LB; n=100) groups. Postoperative patient-controlled intravenous analgesia (PCIA) with hydromorphone (10 mg/180 mL; background: 0 mL/h; bolus: 5 mL; lockout: 15 min) was initiated in all patients. Primary outcomes included pain scores of the Numerical Rating Scale (NRS) at rest and during movement at 6, 12, 24, 36, 48, and 72 hours post-operation; and the cumulative morphine milligram equivalent (MME) at 0-&lt;24, 24-&lt;48, 48-72, and 0-72 hours (including both PCIA and rescue analgesics). Secondary outcomes included PCIA doses, rescue analgesia, and adverse events within 72 hours. Exploratory 3‑month telephone follow‑up assessed pain presence during usual activities and breathing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 200 randomized patients, 184 completed in‑hospital follow‑up (92 per group) and were included in the primary analysis.Sixteen patients were excluded after randomization (3 due to cancelled surgery, 4 due to reoperation, 5 due to postoperative complications, and 4 due to withdrawal of consent). Compared with the control group, the LB group showed significantly lower resting NRS scores at 12, 24, 36, and 48 hours (P=0.04, 0.04, 0.02, and 0.01, respectively) and dynamic NRS scores at all time points (6, 12, 24, 36, 48, and 72 hours) (P=0.02, 0.001, 0.002, 0.04, 0.03, and 0.046, respectively). MME consumption was significantly reduced in the LB group during the 48- to 72-hour interval (P=0.03) and cumulatively over 0-72 hours (P=0.03). The number of delivered PCIA doses was significantly lower in the LB group during the 48- to 72-hour interval (P=0.02), with no significant differences in the 0 to 24- or 24- to 48-hour intervals. Rescue analgesia rates (3.3% &lt;i&gt;vs.&lt;/i&gt; 5.4%, P=0.72) and the incidence of any adverse events (42.4% &lt;i&gt;vs.&lt;/i&gt; 51.1%, P=0.30) did not differ significantly between groups. At 3 months, 175 patients completed follow-up (control: 90; LB: 85); fewer LB patients reported pain (17.6% &lt;i&gt;vs.&lt;/i&gt; 21.1%), though no statistical comparison was performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In thoracoscopic lung tumor surgery, PVB with LB provides improved and sustained postoperative an","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1054"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytology smears from endobronchial ultrasound-guided transbronchial needle aspiration as a source of nucleic acids with adequate yield for next-generation sequencing.","authors":"Asuka Uebayashi, Hideaki Furuse, Yuji Matsumoto, Kenya Sato, Takaaki Tsuchida, Shun-Ichi Watanabe, Yasushi Yatabe","doi":"10.21037/jtd-2026-1711","DOIUrl":"10.21037/jtd-2026-1711","url":null,"abstract":"<p><strong>Background: </strong>Formalin-fixed paraffin-embedded (FFPE) specimens obtained via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are commonly used for next-generation sequencing (NGS), which has become integral to guiding treatment strategies in advanced non-small cell lung cancer (NSCLC). However, the DNA and RNA extracted from these samples often exhibit suboptimal quality, leading to test failure. Although cytology smears are routinely prepared during the processing of EBUS-TBNA specimens, their utility for DNA and RNA extraction remains insufficiently explored. Therefore, in the present study, we aimed to evaluate the DNA and RNA yield and adequacy of cytology smears for NGS analysis.</p><p><strong>Methods: </strong>We retrospectively reviewed data from consecutive patients diagnosed with NSCLC via EBUS-TBNA of mediastinal or hilar lymph nodes who had surplus cytology smear slides prepared at our institution between March 2021 and October 2024. We quantified DNA and RNA yields, defining cases with ≥50 ng of both as sufficient nucleic acid amount for NGS input (SNA). We also performed univariable and multivariable logistic regression analyses to identify factors associated with the SNA threshold.</p><p><strong>Results: </strong>Among 223 patients, the median DNA and RNA yields were 540 (range, 0-22,680) ng and 2,277 (range, 0-26,910) ng, respectively. Adequate yields (≥50 ng) were achieved in 91.5% for DNA and 97.3% for RNA, whereas 89.2% of cases were SNA. Moreover, DNA yield was associated with mediastinal lymph nodes, a larger lesion size on both EBUS and computed tomography (CT), use of a 22-gauge needle, and indistinct margins on EBUS. RNA yield was associated with mediastinal lymph nodes and larger lesion size on EBUS and CT. However, in the univariable and multivariable analyses, no variable was significantly associated with SNA.</p><p><strong>Conclusions: </strong>EBUS-TBNA-derived cytology smears provided sufficient DNA and RNA yield to meet predefined NGS input thresholds. These findings suggest that cytology smears may represent a potentially useful source for NGS, pending validation by sequencing.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1040"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative fractional exhaled nitric oxide in differentiating pulmonary nodules and pathological examination of non-small cell lung cancer: a retrospective cohort study.","authors":"Xue Wang, Huang-Man Xiao, Yong-Yin Gao, Xue-Yan Bian, Yan-Li Qiu, Yue Li","doi":"10.21037/jtd-2026-2191","DOIUrl":"https://doi.org/10.21037/jtd-2026-2191","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Lung cancer remains the leading cause of cancer-related mortality worldwide, and preoperative differentiation of pulmonary nodules remains challenging. We aimed to investigate the clinical value of preoperative fractional exhaled nitric oxide (FENO) in distinguishing benign pulmonary nodules from malignant pulmonary nodules and characterizing its relationship with pathological features of non-small cell lung cancer (NSCLC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;After exclusions from 1,046 consecutive patients, 550 patients were included and classified into malignant (NSCLC) and benign groups based on postoperative pathological examination. Using the Mann-Whitney U test, FENO levels were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was conducted with the optimal cutoff value determined based on the Youden index. Multivariate binary logistic regression analysis was conducted to assess the independent association of FENO with the malignant behavior of NSCLC. In the malignant group, FENO levels were compared across pathological types, tumor-node-metastasis (TNM) stages, and programmed death-ligand 1 (PD-L1) expression groups using the Mann-Whitney U test and the Kruskal-Wallis H test. Subsequently, multivariate linear regression analysis was conducted to explore the independent association between FENO and PD-L1 expression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Preoperative levels of FENO were significantly higher in the malignant group than in the benign group {median [interquartile range (IQR)]: 23 [18-29] &lt;i&gt;vs.&lt;/i&gt; 16 [12-23] ppb, P&lt;0.001}. The clinical/imaging-based model (including age, sex, smoking, and nodule size) achieved an area under the ROC curve (AUC) of 0.597 [95% confidence interval (CI): 0.537-0.657]. After incorporating FENO into the model, the AUC increased significantly to 0.716 (95% CI: 0.657-0.774), indicating that FENO provided incremental diagnostic value, with an optimal cutoff value of 19.5 ppb (sensitivity =70.9%, specificity =66.4%). After adjusting for confounders, FENO remained independently associated with malignancy [odds ratio (OR) =1.094; 95% CI: 1.060-1.128; P&lt;0.001]. In the malignant group, FENO levels were significantly higher in squamous cell carcinoma than in adenocarcinoma (P&lt;0.01). Furthermore, FENO levels differed significantly across PD-L1 expression groups (P&lt;0.001), but not across TNM stages (P=0.52). Multivariate linear regression showed that PD-L1 high-expression group (≥50%) was independently associated with higher FENO levels compared with the negative group (B=0.211; 95% CI: 0.085-0.336; P=0.001), whereas the low-expression group (1-49%) showed no significant association (B=0.030; 95% CI: -0.028 to 0.231; P=0.11) and squamous histological subtype (B=0.290; 95% CI: 0.141-0.440; P&lt;0.001) were independently associated with FENO levels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Preoperative levels of FENO demonstrated moderate diagnostic value for m","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1012"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of uniportal and multiportal robotic-assisted thoracoscopic surgery for non-small cell lung cancer: a systematic review and meta-analysis.","authors":"Zhijing He, Zunhui Wan, Ye Hu","doi":"10.21037/jtd-2026-1982","DOIUrl":"https://doi.org/10.21037/jtd-2026-1982","url":null,"abstract":"<p><strong>Background: </strong>Currently, the comparative efficacy of different robotic surgical systems in the treatment of lung cancer remains unclear. This study aimed to systematically evaluate the differences in efficacy between uniportal robotic-assisted thoracoscopic surgery (URATS) and multiportal robotic-assisted thoracoscopic surgery (MRATS) for the treatment of non-small cell lung cancer (NSCLC).</p><p><strong>Methods: </strong>PubMed, Cochrane Library, Web of Science, and Embase were searched from database inception to March 2026 following standardized retrieval procedures. Two authors independently performed literature retrieval, preliminary screening, full-text reassessment, raw data extraction, and cross-checking. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies, and all statistical analyses were performed using Stata 17.0. This study has been registered on the INPLASY platform (protocol registration number: INPLASY202670008).</p><p><strong>Results: </strong>Nine studies involving 1,827 patients were ultimately included. NOS assessment indicated that all included studies were of moderate-to-high quality. The pooled meta-analysis showed that, compared with MRATS, URATS was associated with a longer operative time [weighted mean difference (WMD) =14.70, 95% confidence interval (95% CI): 6.06-23.35, P=0.04, I²=24.5%] but a shorter length of hospital stay (WMD =-1.07, 95% CI: -1.36 to -0.77), P<0.01, I²=43.3%). No significant differences were observed in 1-year all-cause mortality, infection, air leak, hemothorax, duration of chest tube drainage, intraoperative blood loss, or number of dissected lymph nodes.</p><p><strong>Conclusions: </strong>Compared with MRATS, URATS for NSCLC was associated with a longer operative time but a shorter hospital stay, while no statistically significant differences were observed in the other assessed outcomes. These findings suggest that URATS may be a feasible minimally invasive surgical approach for NSCLC, although further prospective studies are warranted.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1026"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term clinical outcomes of nasoduodenal tube versus feeding jejunostomy after minimally invasive esophagectomy: a retrospective cohort study with exploratory microbiome analysis.","authors":"Qi-Yue Ge, Chang-Yong Wang, Chao Zheng, Hao-Tian Zheng, Yu-Xuan Wen, Jing Luo, Yong Qiang, Yan-Qing Wang, Zhuang-Zhuang Cong, Yi Shen","doi":"10.21037/jtd-2026-1470","DOIUrl":"https://doi.org/10.21037/jtd-2026-1470","url":null,"abstract":"<p><strong>Background: </strong>Esophagectomy remains an effective treatment for esophageal cancer but is associated with severe postoperative complications, in which nutritional status plays a critical role. The optimal route for enteral feeding remains uncertain. To address this uncertainty, we compared the short-term clinical outcomes of the two approaches and exploratorily analyzed the differences in gut microbiota.</p><p><strong>Methods: </strong>This retrospective cohort study enrolled patients who underwent minimally invasive esophagectomy (MIE) for esophageal squamous cell carcinoma (ESCC) between July 2018 and June 2021. Primary outcomes were surgery-related complications (including anastomotic leakage, anastomotic stenosis, pneumonia, respiratory failure, cardiac events, chylothorax, intestinal fistula and bowel obstruction) and catheter-related outcomes (including occlusion, accidental removal, displacement and retention time). Baseline data were extracted from medical records. Propensity score matching (PSM) was applied to control for potential confounders. Intestinal fluid and fecal samples were collected after enteral nutrition for 16S ribosomal DNA (16S rDNA) sequencing.</p><p><strong>Results: </strong>After PSM, a total of 381 patients (nasoduodenal tube: 282; feeding jejunostomy: 153) was finally included. The feeding jejunostomy group exhibited a higher incidence of pneumonia (21.49% <i>vs.</i> 33.99%, P=0.007), respiratory failure (3.07% <i>vs.</i> 13.07%, P<0.001), anastomotic stenosis (1.32% <i>vs.</i> 5.23%, P=0.03) and bowel obstruction (0% <i>vs.</i> 2.16%, P=0.03). Nasoduodenal tube placement was associated with more accidental removal (13.16% <i>vs.</i> 0.65%, P<0.001) and catheter displacement (13.60% <i>vs.</i> 6.54%, P=0.03). The catheter retention time {37 [interquartile range (IQR): 15-40] days <i>vs.</i> 39 (IQR: 37-42) days, P<0.001} was also shorter in nasoduodenal tube group.</p><p><strong>Conclusions: </strong>In this study, nasoduodenal tube placement was associated with a higher incidence of catheter-related complications, whereas feeding jejunostomy was linked to more surgery-related complications. Nasoduodenal tube placement also showed potential functional advantages for the gut microbiome. However, future multi-center randomized controlled trials are still needed to minimize potential confounders and validate the differences between the two enteral nutrition routes.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"18 9","pages":"1024"},"PeriodicalIF":2.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}